Investment in Graduate Medical Education Outcomes: An Analysis of Pediatric GME at the Residency Program Level (2017-18)

Investigators:  Tom Ricketts, PhD, MPH; Erin Fraher, PhD, MPP; Ryan Kandrack, BS


Background: One of the key findings from our Center’s recent study of state innovations in using Medicaid funds to support GME was that states want far more transparency and accountability for public funds invested GME. The majority of states in the US partially fund GME training through Medicaid, with some states using other state appropriated dollars to support GME. Although individual states have spent millions of dollars annually on residency training, our work revealed that states had little to no knowledge of what that investment yields in terms of producing a physician workforce that practices either in the state, in needed specialties, or in underserved locations. A few states, including Ohio and South Carolina, have discussed redistributing GME funds to better divert resources to programs that produce physicians who remain in state or practice in primary care or rural areas. However, to our knowledge, no state, nor the federal government, currently tracks GME outcomes at the training program level, that is, compares the outcomes of residency programs within in state or to other training programs in the U.S. This project is a companion to a separate, but related, project that is developing a toolkit that states could use to evaluate GME training as a whole. This project, however, focuses on a single specialty, pediatrics. Pediatrics is an important element of primary care and also serves as the gateway to sub-specialty practice. This project will test the availability of current data to calculate important metrics that describe value contributed by pediatric GME training programs.

Study aims: This study will explore the feasibility of using different measures to assess the outcomes of pediatric residency programs at the state and national level, including retention in generalist practice, practice in underserved and economically deprived areas and participation in Medicaid. The goal of the project is to develop specific outcomes measures that assess the degree to which pediatric GME institutions and programs are producing a workforce that meets state and national workforce needs. The project will focus on the 220 pediatric residency programs currently preparing generalist pediatricians.

Alignment with BHW priorities: The methodology and outcome of this study will be relevant to the Division of Medicine and Dentistry, COGME, the Children’s Hospitals GME program and various HRSA programs:

  • Primary Care Training and Enhancement (§747)
  • Investment in Tomorrow’s Pediatric Health Care Workforce (§775)
  • Advisory Committee on Training in Primary Care Medicine and Dentistry (§749)
  • Training in Underserved Communities (§749B)
  • Rural Physician Training Grants (§749B)


Related HWRC projects: 

Making Use of Workforce Projections to Inform the Graduate Medical Education Policy Debate in the United States (2014-15)

The Future of Medicaid-Funded Graduate Medical Education as the Health Care System Shifts (2015-16)

DocFlows: Mapping GME Location and Practice Location by Specialty (2016-17)

Exploring the Magnitude and Timing of Physician Specialty Changes (2016-17)

Developing a GME Policy Toolkit that States Can Use to Evaluate Return on Investment for Public Funds Invested in Training (2017-18)

Association Between the Receipt of Title VII Funding for Medical Schools and Physician Workforce Outcomes (2017-18)


Project Products: 

Research Briefs
Presentations, webinars, and refereed conference papers and posters